Experience

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  Oak tree health plan

  Dec 1994 - Jun 2000

  Complaint & grievance coordinator

  • Responsible for receipt of all member complaint /grievance requests and DPW Fair Hearingnotifications, whether written or verbal• Ensured the timely and accurate review, routing and tracking of member and provider issuesin compliance with regulatory requirements• Facilitated communication of and preparation for 1st and 2nd level hearings and providedformal written communication to members and providers at closure of hearings• Prepared mandated reports for governmental agencies, other outside entities, and internaldepartments• Conducted in-services for internal staff on complaint and grievance policies, procedures andprocesses Show less

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  Health partners

  Jul 2000 - May 2014

  Pharmacy analyst

  •Develop and run detailed reports for pharmacy claims, performs analysis and prepares summary results to be presented to management to assist in strategic planning including Generic %, quarterly comparison reports and yearly trending graphs.•Trend analysis of pharmacy utilization for formulary compliance and contract compliance of clients. •Analyze claims data to indentify and target inappropriate claim patterns in order to increase recoveries.•Claims analysis to support financial and formulary strategic objectives•Analyze and develop detailed ad hoc reports for specialty products, internal (SIU, C&G) or external departments or for vendors.•Prepare trend reports for rebate analysis and formulary compliance to contracts•Maintain GeoAccess of pharmacy network including Pharmacy Network Termination process Show less

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  Performrx

  May 2014 - Nov 2016

  Pharmacy systems analyst

  Responsible to ensure claims adjudication accuracy based on requested logic. Manage the accurate and timely implementation of claims adjudication logic and process. Heavily involved in New and Renewing Business Implementation, testing verification and coordination with all pharmacy systems.

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  Moravia health

  Jul 2020 - now

  • Account Manager

    Jul 2021 - now

  • Account Manager

    Jul 2020 - now